Abstract

Introduction

Older age is associated with higher prevalence of chronic illness and functional impairment,
contributing to an increased rate of hospitalization and admission to intensive care.
The primary objective was to evaluate the rate, characteristics and outcomes of very
old (age ≥ 80 years) patients admitted to intensive care units (ICUs).

Methods

Retrospective analysis of prospectively collected data from the Australian New Zealand
Intensive Care Society Adult Patient Database. Data were obtained for 120,123 adult
admissions for ≥ 24 hours across 57 ICUs from 1 January 2000 to 31 December 2005.

Results

A total of 15,640 very old patients (13.0%) were admitted during the study. These
patients were more likely to be from a chronic care facility, had greater co-morbid
illness, greater illness severity, and were less likely to receive mechanical ventilation.
Crude ICU and hospital mortalities were higher (ICU: 12% vs. 8.2%, P < 0.001; hospital: 24.0% vs. 13%, P < 0.001). By multivariable analysis, age ≥ 80 years was associated with higher ICU
and hospital death compared with younger age strata (ICU: odds ratio (OR) = 2.7, 95%
confidence interval (CI) = 2.4 to 3.0; hospital: OR = 5.4, 95% CI = 4.9 to 5.9). Factors
associated with lower survival included admission from a chronic care facility, co-morbid
illness, nonsurgical admission, greater illness severity, mechanical ventilation,
and longer stay in the ICU. Those aged ≥ 80 years were more likely to be discharged
to rehabilitation/long-term care (12.3% vs. 4.9%, OR = 2.7, 95% CI = 2.6 to 2.9).
The admission rates of very old patients increased by 5.6% per year. This potentially
translates to a 72.4% increase in demand for ICU bed-days by 2015.

Conclusions

The proportion of patients aged ≥ 80 years admitted to intensive care in Australia
and New Zealand is rapidly increasing. Although these patients have more co-morbid
illness, are less likely to be discharged home, and have a greater mortality than
younger patients, approximately 80% survive to hospital discharge. These data also
imply a potential major increase in demand for ICU bed-days for very old patients
within a decade.